International Stroke Conference
Pre-Conference Symposia: February 18, 2020
Sessions: February 19–21, 2020

Rachel Forman, MD

I had the privilege to attend this important symposium shedding light on different aspects of stroke disparities. As someone who is passionate about stroke community education and addressing healthcare disparities, it was really incredible to be able to listen in person to people I have admired throughout my training.  The symposium was moderated by Drs. Bruce Ovbiagele and Amytis Towfighi. 

The first talk was by Dr. Mitchell Elkind (Columbia University), who began by describing disparities: “… a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” He also mentioned that approximately 1/3 of people in the United States, or more than 100 million people, identify as belonging to a racial or ethnic minority population. Another interesting point from the discussion is that Hispanic and Asian men and women are less likely to use EMS versus white men and women, and that black women are less likely than white women to use EMS (Journal of the American Heart Association, Smith 2015). We were then introduced to his work with the Northern Manhattan Study (NOMAS): a study of the population in Washington Heights (beginning in 1990) that has enrolled over 4,400 people from the surrounding community with neurological conditions. This work is ongoing and exciting (and, importantly, includes a diverse patient population).

Next, we heard from Dr. Mary Cushman (University of Vermont), who discussed the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Project, a national study looking into stroke risk factors focusing on geographic and racial differences. She mentioned that about 50% of the disparities were related to differences in typical vascular risk factors; however, the other 50% may be related to factors such as genetics. Interestingly, sickle cell trait was not a risk factor for ischemic stroke. Lipoprotein (a), which promotes lipid/inflammatory pathways in atherosclerosis and enhances abnormal clotting, is more common in black people compared to white people and may be a race-specific stroke risk factor. Additionally, AB blood type and FVIII are more common in blacks. It was really nice to hear about these risk factors from the perspective of a hematologist!

Dr. Bernadette Boden-Albala (University of California-Irvine) began by discussing the ASPIRE Study, addressing lack of stroke education, especially in underserved communities, and how this affects patients receiving timely care. They used a community-engaged approach targeting underserved black DC communities and increased the amount of patients arriving to the ED <3 hours and receiving tPA. This was particularly special for me to hear about as it relates to my goals in the Boston underserved communities. She also mentioned some important facts: Minorities are less likely to use EMS services with delayed arrival times to the ED, and, on average, African Americans are 2-4 times less likely than whites to receive carotid endarterectomy even after risk adjustment. Another important point mentioned was that even when blacks arrived within the tPA window, they were less likely to receive tPA compared to whites (Hsia. Stroke. 2011). 

Next, we heard from Dr. Lesli Skolarus (University of Michigan), who described her work with the community in Flint, MI. I have admired the work Dr. Skolarus has done for many years, and she demonstrates how much one can do when they work from the heart and build strong relationships built on trust and respect with the surrounding community. She differentiated community-based research (research in a community) versus community-based participatory research (research with a community). She transitioned into the next part of the talk with an interactive, small group activity. The task was looking at a hypothetical situation of a population exposed to contaminated water and how to approach this as not only healthcare providers, but also engaging with the local community. She then transitioned into her own experience with working with the community in Flint when they experienced their water crisis. She also showed a video of her community partner describing her experience working with healthcare providers.  Her talk ended by providing advice about how to be a successful academic partner, including listening, connecting to larger resources, and helping as not only a researcher, but also as a person.

The morning session concluded with a dedication to Dr. Edgar J. Kenton III, a physician dedicated to his patients, research, education, and improving healthcare disparities. Also known as a family man, his daughter was in the audience to show her support. The recipient of his award was well-deserving Dr. Ralph Sacco, who then delivered the inaugural Kenton Lecture. Dr. Sacco discussed his personal experiences of his career largely dedicated to improving healthcare disparities. He reviewed NOMAS and its evolution over the years, as well as the Florida-Puerto Rico Collaboration, a voluntary registry that aims to increase the number of Latino patients included in stroke research. One interesting point from the NOMAS review was about cardiovascular health and how, among all ethnic backgrounds, no patients had all 7 ideal cardiovascular health characteristics. Only 15.3% of women and 25% of men in general had >4 characteristics, with white patients having higher numbers compared to black and Hispanic patients (Circulation 2012). 

I am grateful to have attended this symposium and that these presenters who have devoted their careers to such an important cause were recognized and given a platform to share their inspirational work.